Telestroke consultation for occluded cerebral artery
Subject: A 71-year-old man with stroke symptoms arrived at Peace Harbor Hospital in Florence by ambulance the afternoon of March 17.
Diagnosis: Triage nurse Cynthia Russell evaluated the patient and summoned emergency room physician Matthew J. Danigelis, MD. Within five minutes of arrival, the patient was in the CT scanner. Images revealed an occluded left middle cerebral artery, indicated in Image A by the yellow arrow. Within a half-hour, Dr. Danigelis was engaged in a telestroke consultation with neurointensivist-neurohospitalist Elaine Skalabrin, MD, and other experts at Sacred Heart Medical Center at RiverBend. The team decided to administer tissue plasminogen activator (tPA) to dissolve the clot occluding the artery prior to transport to SHMC at RiverBend.
Treatment: A perfusion CT scan was performed upon arrival at SHMC at RiverBend. The green area in Image B represents the ischemic penumbra. The red area is the infarct core. Agiogram Image C clearly indicates complete occlusion of the left middle cerebral artery (yellow arrow). The Sacred Heart team used the Penumbra System to remove the clot. (The Penumbra System is a package of tools used by neuro interventional specialists to remove clots from the large vessels of the brain.) Clot removal was successful as illustrated in Image D. The yellow arrow points to the former location of the occlusion. The CT scan in Image E was taken after the procedure. The yellow oval indicates the final area of stroke, which is much smaller than the ischemic penumbra in Image B. The patient's stroke was much smaller than it would have been without the treatment.
Outcome: The patient was discharged a month later from the Oregon Rehabilitation Center at Sacred Heart Medical Center, University District. He was walking independently and speaking normally, with some fine coordination problems in his right hand (patient is right-hemisphere dominant). The patient calls Dr. Skalabrin "my movie star doctor" because he first met her over the telestroke screen.